DA Billing to Debt Manage: Medical Aids: Medical Aid Lists

Medical Aids: Medical Aid Lists

List of all the Medical Aids Options grouped by the Scheme.

Sign in to the GoodX Desktop using your GoodX username and password.
From the Navigator Double Click on the MedDebs Module

The Main MedDebs screen will open

From the Menu bar, click on Lists

From the drop-down, Click on Medical Aids

From the submenu, Click on Medical Aid lists

You will be directed to the Medical Aid Options screen

Columns

Option Code: Unique code linked to the medical aid option
Option Name: Name of the medical aid option plan
Credit Controller: Specific person/credit controller linked to each medical aid who is responsible for collecting the money from the medical aid
Switch: Which Switch is used to send claims to the medical aid
EDI Route Code: The route number to where the EDI will be delivered, each medical aid has specific routing codes that will determine where the claim is delivered
Scheme Code: Medical Aid Scheme number
Admin Code: The code of the administrator
Administrator: Who administrates the specific Medical Aid

Please Note: All options that are highlighted red have been discontinued and should not be used

Filter

You can filter for a specific Medical Aid by :

Administrator: Who manages this medical aid
Scheme: Medical Aid Name
Option: Plan name

Adding a New Medical Aid Option

Disclaimer: It is not recommended or advised to add your own Medical Aid Option, it is suggested that the service provider requests be added by contacting either GoodX or Medprax directly as Medprax manages the information

Add a new Medical Aid Option by clicking on the + button

The Medical Aid Option Setup screen will open

Fill in all the relevant information

Sub Option: Option Type -Select from the drop-down list

Acute: Short Term or Day to Day
Chronic: Long term illnesses
Chemotherapy: Cancer Patients
PAT: Pathology

Code: The unique code that has been allocated to the specific plan
Option Name: Plan/Option Name
Scheme: Medical Aid Name
Administrator: Who administrates the Medical Aid
Address 1: Company Address
Address 2: Company Address
Fax Number: The number where they receive faxes
Phone Number: The number where they can be reached telephonically
E-Mail: The address where electronic mail can be sent
URL: The website address
Clearing House: By clicking on the ellipse ... You will be directed to the Clearing House screen where you can add an option from the list
Phone Number: Will be filled in automatically once you have selected an option
Managed Care: You will be directed to the Managed Care Options screen where you can add an option from the list
Phone Number: Will be filled in automatically once you selected an option
Prefix: This will be determined by Medprax and should be left blank
Suffix: This will be determined by Medprax and should be left blank

Requirements

Requires Pre-Auth: Requires Pre-Authorization
Auth required for specific unit types: Authorization is needed for specific unit types
Requires ICD10: Requires an International Classification of Diseases code
Requires CPT4: Requires a Current Procedural Terminology, 4th Edition code

Preferred provider: Indicates whether the option is a preferred provider when the check box is ticked

Levy Button will open the Pharmacy Rule screen

When you are satisfied with what you have done, Click on Post, to save the Details and add it to the Medical Aid to the list

EDI

You are also able to add the EDI Information on the right side of the screen

EDI Codes: The EDI codes used to switch

QEDI: (Discontinued-No Longer in use)
SwitchOn: (Discontinued-No Longer in use)
GoodXSwitch: The EDI code used in GoodXSwitch

Edi Switches:

Batch (QEDI): Use batch QEDI to switch (Discontinued-No Longer in use)
GoodX Switch: Uses GoodXSwitch to switch claims (Discontinued-No Longer in use )
Private: Switch privately - Patients pay Cash/Credit card/EFT

Billing Procedures

You can set up the Billing Procedures by clicking on the Billing Procedure Tab

Determine tariff when capturing invoices:

Reference pricing

None: Does not use reference pricing
MMAP: Maximum Medical Aid Price
MPL: Maximum Possible Loss
Mediscor: Use Mediscor Pricing
MNMP: Maximum Namibia Medicine Price
CAP: An agreement obligating the seller to make payments
QMP: Quality Medical Publishing

Consultations /Procedures/Material

Claim directly from Medical Aid: Will be claimed from the Medical Aid on behalf of the patient
Patient pays and claims from Medical Aid: Patient will pay for Consultations /Procedures/Materials at the practice and claim from the medical after

CCA Invoice Group Status (Procedures): Options will appear when CCA is setup

CCA Invoice Group Status (Lab): Options will appear when CCA is setup

Billing: Medicines

You can set up the Billing: Medicines by clicking on the Billing Medicines Tab

No dispensing: Non-Dispensing practices will check this box

Medicine

Claim directly from Medical Aid: Will be claimed from the Medical Aid on behalf of the patient
Patient pays and claims from Medical Aid: Patient will pay for the medication at the practice and claim from the medical after

CCA Invoice Group Status (Medicine): Options will appear when CCA is setup

Sales Price for stock items

Normal: Price with added mark-up
Sell all stock products at cost price: Stock will be sold for the same amount as what the practice paid for it